Prevalence of anxiety during the COVID-19 pandemic in patients diagnosed with subglottic stenosis.

OBJECTIVES: In the wake of the novel coronavirus disease (COVID-19), patients with subglottic stenosis (SGS) have a new, seemingly ubiquitous, respiratory disease to contend with. Whether real or perceived, it is likely that patients with SGS will feel exposed during the current pandemic. This study seeks to determine whether patients with SGS have increased rates of anxiety during the COVID-19 pandemic relative to healthy controls, as well as how much of an impact the pandemic itself plays in the mental health of this population. METHODS: Retrospective review of 10 patients with a confirmed SGS diagnosis and 21 control patients were surveyed via telephone. Patients of all ages that had an in-person or virtual visit within 3 months of the survey start date were included. RESULTS: A total of 30 patients were surveyed in this study, of whom 67.8 % were in the control group and 32.2 % were comprised of patients diagnosed with SGS. SGS patients reported a significantly higher level of anxiety on the GAD-7 scale with severe anxiety in 20 % of patients, moderate anxiety in 50 % of patients, mild anxiety in 20 %, and 10 % reporting no anxiety. Overall, the average reported GAD-7 score of the SGS patients and control patients were 10.8 ± 4.96 and 6.67 ± 2.96 respectively (p < 0.05). CONCLUSIONS: This study is the first of its kind to analyze the rates and causes of anxiety within the context of the COVID-19 pandemic on patients diagnosed with subglottic stenosis. SGS patients were found to have a significantly higher anxiety based on the GAD-7 survey in comparison to patients without SGS. LEVEL OF EVIDENCE: IV.

Rapid implementation of COVID-19 tracheostomy simulation training to increase surgeon safety and confidence.

OBJECTIVE: To determine if rapid implementation of simulation training for anticipated COVID-19 tracheostomy procedures can increase physician confidence regarding procedure competency and use of enhanced personal protective equipment (PPE). METHODS: A brief simulation training exercise was designed in conjunction with the development of a COVID-19 Tracheostomy Protocol. The simulation training focused primarily on provider safety, pre and post-surgical steps and the proper use of enhanced PPE. Simulation training was performed in the simulation lab at the institution over 2 days. Pre and post self-evaluations were measured using standardized clinical competency questionnaires on a 5-point Likert Scale ranging from "No knowledge, unable to perform" up to "Highly knowledgeable and confident, independent." RESULTS: Physicians self-reported a significant increase in knowledge and competency immediately after completing the training exercise. Resident physicians increased from a mean score of 3.00 to 4.67, p-value 0.0041, mean increase 1.67 (CI 95% 0.81 to 2.52). Attending physicians increased from a mean score of 2.89 to 4.67, p-value 0.0002, mean increase 1.78 (CI 95% 1.14 to 2.42). Overall, all participants increased from a mean score of 3.06 to 4.71, p-value 0.0001, mean increase 1.65 (CI 95% 1.24 to 2.05). DISCUSSION: Implementation of this simulation training at our institution resulted in a significant increase in physician confidence regarding the safe performance of tracheostomy surgery in COVID-19 patients. IMPLICATIONS FOR PRACTICE: Adoption of standardized COVID-19 tracheostomy simulation training at centers treating COVID-19 patients may result in improved physician safety and enhanced confidence in anticipation of performing these procedures in real-life scenarios.